HEART PART I. A group of Lincoln, Neb., heart specialists plans to build a 48-bed, $30 million for-profit heart hospital. The Nebraska Heart Institute, made up of 17 cardiologists and six surgeons, received city approval for the 75,000-square-foot facility, with a scheduled spring 2003 opening.
The physician shareholders will be the sole investors in the Nebraska Heart Hospital and hope to secure additional financing. NHI doctors say they intend to continue practicing at Lincoln's existing hospitals. Meanwhile, the 583-bed BryanLGH Medical Center plans to open its own heart institute as a joint venture with a different group of seven cardiologists and three surgeons.
HEART PART II. South Denver Cardiology Associates is building a $14 million, 60,000-square-foot heart center that will offer diagnostic imaging and extensive preventive services. The center also will include a 10,000-square-foot exercise facility and a 125-seat theater for heart health education classes. The physician-owned outpatient center will not compete with local hospitals for coronary interventions or other inpatient procedures, says cardiologist Karyl VanBenthuysen, M.D., president of the 12-physician group.
"We hope to provide an established series of lectures together with a structured program of baseline evaluation all under one roof where we can oversee patients' progress," VanBenthuysen says.
"(The hospitals') legitimate concern is about how numbers will be affected at their outpatient diagnostic cath labs. But we anticipate that their inpatient hospital volume will actually increase as a result of our early screening for coronary disease."
SDCA also is partnering with anesthesiologist James Ehrlich, M.D., founder of Denver-based Colorado Heart Imaging, to provide CT scanning services at the new center.
QUALITY GAPS. After crunching patient data for the years 1998 through 2000, HealthGrades of Lakewood, Colo., found vast differences in treatment variability in hospitals.
Of the 900 cardiac programs HealthGrades evaluated, mortality rates at those with the lowest ranking were nearly twice as high as those within the top tier.
Of 3,950 acute care hospitals treating patients for stroke, the quality assessment group found nearly the same 2-to-1 spread between the worst to the best programs. In both cases, the data was adjusted for risk.
Projecting those spreads onto a national population, nearly 5,900 patients died last year, and more than 17,000 died in the three-year period, who might not have perished had they sought treatment from the highest-ranking providers, according to the company.
CONTRACTING DEAL. The Federation of Physicians and Dentists has agreed to stop engaging in illegal joint contract negotiations and boycotts, according to the Department of Justice. The agreement prohibits the group from forcing health plans to pay increased physician fees and settles a suit filed in 1998 by the department that alleged orthopedic members in Delaware engaged in anti-competitive activities.
The suit alleged that the orthopedic surgeons in Delaware were recruited by the federation, then designated its executive director as their agent to negotiate with Blue Cross Blue Shield of Delaware. When the Blues declined to negotiate with the federation, most orthopedist members terminated their contracts with the Blues, according to the complaint.
Under the settlement, the federation can continue to act as a third-party messenger in negotiations between independent physicians and health plans.
GATE UNLOCKED. Humana will allow enrollees in some states to bypass the gatekeeper requirement synonymous with HMOs.
More than 250,000 enrollees in Ohio, Kentucky and Tennessee will no longer have to go to their primary care physician to get referrals to see specialists, but those bypassing their PCPs will face higher co-payments. The changes take effect Jan. 1 and affect Humana/ChoiceCare enrollees.
Humana still will require approval for hospital admission and mental healthcare. Humana doesn't plan to extend the policy nationwide but will continue to study the idea.
RECORD DEFINITIONS. In the thousands of pages of HIPAA transaction, privacy and security regulations for healthcare data, HHS officials neglected to define just exactly what constitutes a medical record. So the American Health Information Management Association came up with guidelines for healthcare organizations to establish definitions that are appropriate for various state laws and medical practice settings.
"AHIMA decided that for litigation purposes, this was necessary," says Michelle Dougherty, practice manager of the Chicago-based organization. For example, she says, not every medical entity is subject to HIPAA, nor do the regulations cover personal health records maintained by individual patients.
A task force of 15 healthcare executives, consultants and attorneys drafted the guidelines and published its recommendations in the Journal of AHIMA last month.